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REVIEW article

Front. Neurol.
Sec. Neuroinfectious Diseases
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1465787
This article is part of the Research Topic An Update on Neurological Disorders Post COVID-19 Infection Vol 2: cardiovascular effects, neuro-cardiac and neuro-respiratory autonomic dysfunctions View all 9 articles

Neurological Sequelae of Long COVID: A Comprehensive Review of Diagnostic Imaging, Underlying Mechanisms, and Potential Therapeutics

Provisionally accepted
Grant McGee Talkington Grant McGee Talkington 1,2,3*Paresh Kolluru Paresh Kolluru 3Timothy E Gressett Timothy E Gressett 2Saifudeen Ismael Saifudeen Ismael 2Umar Meenakshi Umar Meenakshi 2Mariana Acquarone Mariana Acquarone 2Rebecca Solch-Ottaiano Rebecca Solch-Ottaiano 2Amanda White Amanda White 2Blake Ouvrier Blake Ouvrier 2Kristina Pare Kristina Pare 3Nicholas Parker Nicholas Parker 3Amanda Watters Amanda Watters 4Nabeela Siddeeque Nabeela Siddeeque 4Brooke Sullivan Brooke Sullivan 3Nilesh Ganguli Nilesh Ganguli 4Victor Calero-Hernandez Victor Calero-Hernandez 2Gregory Hall Gregory Hall 2Michelle Longo Michelle Longo 3Gregory Jaye Bix Gregory Jaye Bix 1,2,4
  • 1 Neuroscience Program, Tulane University, New Orleans, United States
  • 2 Tulane Brain Institute, School of Science and Engineering, Tulane University, New Orleans, Louisiana, United States
  • 3 Tulane University, New Orleans, Louisiana, United States
  • 4 School of Medicine, Tulane University, New Orleans, Louisiana, United States

The final, formatted version of the article will be published soon.

    One lingering effect of the COVID-19 pandemic created by SARS-CoV-2 is the emergence of Long COVID (LC), characterized by enduring neurological sequelae affecting a significant portion of survivors. This review provides a thorough analysis of these neurological disruptions, which broadly manifest as chronic insomnia, fatigue, mood dysregulation, and cognitive impairments like brain fog. Furthermore, we characterize how diagnostic tools such as PET, MRI, EEG, and ultrasonography provide critical insight into subtle neurological anomalies that may mechanistically explain the Long COVID disease phenotype. In this review, we explore the mechanistic hypotheses of these neurological changes, which describe CNS invasion, neuroinflammation, blood-brain barrier disruption, and gut-brain axis dysregulation, along with the novel vascular disruption hypothesis that highlights endothelial dysfunction and hypoperfusion as a core underlying mechanism. We lastly evaluate the clinical treatment landscape, scrutinizing the efficacy of various therapeutic strategies ranging from antivirals to anti-inflammatory agents in mitigating the multifaceted symptoms of LC.

    Keywords: Long Covid, post-acute sequalae of COVID-19, SARS- CoV- 2, Neurological complication, Chronic Insomnia in COVID-195, post-COVID fatigue, cognitive impairment, brain fog

    Received: 16 Jul 2024; Accepted: 18 Nov 2024.

    Copyright: © 2024 Talkington, Kolluru, Gressett, Ismael, Meenakshi, Acquarone, Solch-Ottaiano, White, Ouvrier, Pare, Parker, Watters, Siddeeque, Sullivan, Ganguli, Calero-Hernandez, Hall, Longo and Bix. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Grant McGee Talkington, Neuroscience Program, Tulane University, New Orleans, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.